1689980963 NPI number — MRS. EMILY GRACE MENTIN-CHAMBLE LMSW

Table of content: MRS. EMILY GRACE MENTIN-CHAMBLE LMSW (NPI 1689980963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689980963 NPI number — MRS. EMILY GRACE MENTIN-CHAMBLE LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENTIN-CHAMBLE
Provider First Name:
EMILY
Provider Middle Name:
GRACE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MENTIN
Provider Other First Name:
EMILY
Provider Other Middle Name:
GRACE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1689980963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
79-01 BROADWAY
Provider Second Line Business Mailing Address:
MANAGED CARE, D1-01
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11373-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-334-1921
Provider Business Mailing Address Fax Number:
718-334-3432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90-37 PARSONS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-334-6400
Provider Business Practice Location Address Fax Number:
718-334-6430
Provider Enumeration Date:
08/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  077496 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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